Senior Medical Billing and Collections Manager

FORTA’S MISSION:

Forta is clearing the path to quality healthcare by delivering the best possible outcomes with the utmost convenience. 1 in 36 children [CDC, 2023] is diagnosed to be on the autism spectrum.  Currently, autism support via Applied Behavior Analysis (ABA) is difficult to access and the delivery model must be expanded to provide earlier access to families.  

Forta is not only providing ABA services to our clients, but we’re also improving the future of the ABA experience for families by creating software and predictive algorithms that elevate clinicians to work smarter by surfacing the latest and most relevant case data.  We are working diligently to continuously improve the patient journey and deliver personalized care by applying smart technology and investing in the growth of our world-class team.  

Overview:

We are seeking a dynamic and hands-on Senior Medical Billing and Collections Manager to join our startup team. This role is pivotal in ensuring the smooth operation of our billing and collections processes, and it requires someone who is not only comfortable with data and reporting but also eager to jump in, streamline processes, and provide leadership to the team. The ideal candidate will be proactive in managing day-to-day operations, coaching team members, and continuously seeking improvements to drive the department forward.

Key Responsibilities:

Billing Management:

- Oversee and manage the daily operations of the medical billing department, ensuring the accurate and timely submission of claims to insurance providers, including Medicare, Medicaid, and direct patient billing.

- Ensure proper coding practices and compliance with payer requirements to optimize reimbursement and minimize claim rejections.

- Assign, monitor, and prioritize claims processing, proactively resolving issues that may delay payments.

- Conduct regular audits of billing processes to ensure alignment with industry regulations, including ICD and CPT coding standards.

Collections Management:

- Develop and implement strategies to minimize outstanding receivables, ensuring consistent cash flow.

- Monitor aging reports, following up on unpaid or denied claims, and coordinate with payers or patients to resolve payment issues.

- Negotiate payment plans with patients, handle escalated billing inquiries, and manage disputes with professionalism.

- Oversee external collection agency relationships and ensure appropriate escalation procedures are in place for unresolved accounts.

Team Leadership and Development:

- Lead, mentor, and provide hands-on training to the billing and collections team, ensuring adherence to company policies and achievement of departmental performance goals.

- Conduct regular team meetings to review key performance metrics, share updates on policy or procedural changes, and foster continuous process improvement.

- Assess staffing needs, participate in recruitment, and manage team schedules to maintain optimal departmental productivity.

- Offer constructive feedback and actively coach team members to create a collaborative and high-performing environment.

Reporting and Data Analysis:

- Generate, analyze, and present detailed reports on billing and collections performance, identifying trends, opportunities, and areas for improvement.

- Report key performance indicators (KPIs) to senior management, including collection rates, denial rates, and days in accounts receivable (AR).

- Leverage data analysis to implement corrective actions and optimize revenue cycle performance, ensuring timely and accurate financial reporting.

- Excel in data manipulation and provide clear, actionable insights through reporting tools.

Compliance and Regulatory Oversight:

- Ensure all billing and collections activities adhere to federal, state, and local regulations, including HIPAA, Medicare, Medicaid, and other payer-specific requirements.

- Stay informed of changes in billing codes, payer policies, and healthcare regulations, ensuring the team is regularly updated and compliant.

- Proactively monitor regulatory updates and adjust internal processes as needed to remain in compliance with industry standards.

Technology and Process Improvement:

- Partner with IT and cross-functional teams to optimize the use of billing software, enhancing system capabilities to improve efficiency and accuracy.

- Identify and implement process improvements within the billing and collections workflow, focusing on automating tasks where feasible.

- Oversee system updates and ensure all staff receive necessary training on new software features and process changes.

Strategic Leadership:

- Lead the development and execution of strategic plans for the billing and collections department, aligning initiatives with the broader organizational objectives.

- Collaborate with senior leadership to set financial goals, budgets, and forecasts for the department, contributing to the overall financial strategy of the organization.

- Provide leadership and vision to drive performance, ensuring the team meets departmental and organizational targets.

Risk Management and Compliance:

- Maintain up-to-date knowledge of healthcare billing and collections regulations, ensuring compliance with HIPAA, Medicare, Medicaid, and other payer requirements.

- Implement risk mitigation strategies within billing and collections processes to minimize legal and financial exposure.

- Ensure the team adheres to industry best practices and maintains compliance with changing regulatory landscapes.

• 7+ years of experience in medical billing and collections, with at least 3 years in a leadership or managerial role.
• Strong experience in healthcare billing, coding (ICD, CPT, HCPCS), claims processing, and payer regulations, including Medicare and Medicaid.
• Proven track record of managing teams and improving billing and collection operations in a healthcare setting.
• Demonstrated ability to reduce AR days, improve cash flow, and optimize revenue cycle processes.

• In-depth knowledge of healthcare billing systems and revenue cycle management. 
• Strong leadership and team management skills, with the ability to motivate and develop high-performing teams.
• Proficiency in data analysis and reporting, with advanced skills in
• Excel Excellent communication, problem-solving, and negotiation skills to manage payer relations, patient inquiries, and disputes.
• Strong understanding of healthcare regulations and compliance, including HIPAA, Medicare, Medicaid, and other payer-specific requirements.
• Ability to work cross-functionally with IT, finance, and clinical teams to drive process improvements and technology initiatives.

Apply Today! 

We are looking for you! A driven, innovative, client-focused individual to join our team as we innovate the care and tools available to neuro-diverse families. If this position sounds like the opportunity you have been searching for, we want to speak with you!  

 We look forward to working with you! 

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Forta is a Drug-Free Workplace/ EO employer – M/F/Veteran/Disability.